Clinical and Radiographic Outcomes of Open Transforaminal Lumbar Interbody Fusion with or without Bilateral Wide Laminectomy

Introduction: This study evaluates baseline risk profiles for patients undergoing a 1-2 level open transforaminal lumbar interbody fusion (TLIFs) without direct decompression and patients who require direct decompression in the form of a bilateral wide laminectomy. In this study surgical characteristics, intraoperative/postoperative complications, and radiographic outcomes were compared between adult patients who underwent an open TLIF and those who underwent a TLIF procedure with a bilateral wide laminectomy.

Aims/

Objectives: To evaluate if the addition of a bilateral laminectomy to an open TLIF procedure may confer increased risk for longer operative time, length of stay, and postoperative complications. To determine whether TLIF with or without wide laminectomy impacted disc height restoration.

Methods: A single-center retrospective analysis of adult patients who underwent 1-2 level open TLIFs with two-year radiographic follow-up. Patients were dichotomized depending on whether or not they received a same level bilateral wide laminectomy, independent of the TLIF procedure. Independent sample t-tests and chi-square analysis were used to compare demographics, clinical characteristics, surgical characteristics, and postoperative variables. The radiographic analysis compared disc height restoration from baseline to 2-year follow-up. Disc height was measured pre and postoperatively using an average of the anterior and posterior disc heights from a lateral radiograph.

Results: This cohort contains a total of 138 patients, 63 patients who had an open TLIF alone, and 75 patients who underwent an open TLIF with a bilateral wide laminectomy. Patients who underwent TLIF with a laminectomy were significantly older than those who underwent TLIF alone (57.46 vs 63.80, p=0.002), and had a significantly higher Charlson Comorbidity Index (CCI) (2.14 vs 2.82, p=0.029). The TLIF alone group also had significantly higher pre-op radiculopathy (64.4% vs 43.1%, p=0.014), degenerative disc disease (DDD) (50.0% vs 23.5%), and herniated nucleus pulposus (HNP) (40.0% vs 19.6%, p=0.013). The TLIF with laminectomy had a significantly higher operative time (197.40 vs 2333.16, p=0.001), though there was no difference in estimated blood loss (EBL) and length of stay (LOS). Postoperative outcome analysis revealed the TLIF group with laminectomy had a significantly higher percentage of postoperative peripheral neuropathy (1.1% vs 9.8%, p=0.014), however, there was no difference in reoperations within 2 years between the groups. The TLIF with laminectomy group achieved a significantly higher disc height restoration (6.38 vs 8.08, p=0.017) than the TLIF alone group.

Conclusions: Patients who underwent open TLIF with wide laminectomy were more commonly older with higher CCI than TLIF-alone patients. Although the addition of the laminectomy procedure to TLIF conferred a significant increase in operative time, and an increase in peripheral neuropathy postoperatively, disc height restoration was significantly higher.